ABSTRACT

It has not been possible until recently to elucidate clearly the effect of timing of dialysis initiation on life expectancy and quality of life in dialysis patients. Some studies support the benefits of early initiation of dialysis, while some investigators sustain the idea that this may have deleterious effects on patient survival. In a large-scale randomized controlled trial published in 2010, no difference was detected in life quality and survival between patients who started dialysis early versus late. Early initiation of dialysis has some potential disadvantages such as lack of patient education about other types of renal replacement therapies, earlier loss of residual renal function, increased rate of use of vascular access catheters, and higher health expenditures. Bearing in mind these factors, it is more rational to make the decision to start dialysis by combining the laboratory data with clinical symptoms and signs instead of merely deciding according to the estimated glomerular filtration rate and other laboratory results. In light of the recent published studies, it is expected that all the guidelines about the initiation of dialysis are to be changed in the future years.